Cholesterol and statins

Cholesterol and statins

Let’s start at the very beginning, as they say. Pin your ears back and concentrate, because although I have tried to put all this in sensible language it’s all a bit technical and difficult!

Let’s start with cholesterol.

Cholesterol is...

A sterol found widely in animal and plant tissues. It is a main component of blood plasma and cell membranes, and it is an important precursor of many steroid hormones (such as the estrogens, testosterone, and cortisol), vitamin D₂, and bile acids. In vertebrates, cholesterol is manufactured by the liver or absorbed from food in the intestine. Higher than normal amounts of cholesterol in the blood are associated with higher risk for developing coronary artery disease and atherosclerosis. Chemical formula: C₂₇H₄₆O. (The Free Dictionary n.d.)

Cholesterol is very important, and our bodies produce between 800-1500 mg each day. This is used in a variety of metabolic processes:-

• ·         Cholesterol strengthens all our cell walls and helps in the exchange of nutrients and waste across membranes
• ·         Nearly a quarter of the body’s store of cholesterol is contained in the central nervous system, It is essential for the conduction of nerve impulses.
• ·         Bile acids are formed from cholesterol, and help us to digest fat.
• ·         Cholesterol assists in the formation of some of our hormones.
• ·         In the skin, cholesterol helps us to convert sunlight to vitamin D, and makes our skin resistant to chemicals and disease organisms (Segala & Life Extension Foundation. 2003).

So, we need it but there is good and bad cholesterol.

So-called ‘good cholesterol’ is high density lipoproteins or HDL, and helps reduce cardiovascular disease. To do this there needs to be between  50-70 mg/dL in your blood  (Segala 2003).

‘Bad cholesterol’  is low density lipoprotein or LDL, and this is the stuff that builds up in your arteries and increases your risk of cardiovascular disease or CV (American Heart Foundation n.d.).

Triglycerides and Lp(a) cholesterol are two other components of your cholesterol blood test, and for more information on these please check out the American Heart Foundation site.

LDL cholesterol is the focus of this article, along with statins, a group of drugs that lower LDL in the blood.

Lipoproteins are also known as lipids, and an abnormal amount of lipids, or a disordered lipid metabolism, is known as dyslipedemia. So, if your doctor gives you a cholesterol test and tells you that your levels are too high and you need statins, then you have dyslipidemia. And this puts you at risk of cardiovascular disease, particularly if you have diabetes or or any of the other risk factors, such as  tobacco use, alcohol use, obesity, hypertension, high cholesterol, physical inactivity and unhealthy diet  (World Heart Federation 2013; Mooradian 2009) . Dyslipidemia is found in 70-90% of patients with coronary heart disease (Neely 2012; Agoşton-Coldea et al. 2007) and in 50% of cases of early heart disease has been found to be due to inheritance, a.k.a familial dyslipidemia. In the other 50% of cases the dyslipidemia was due to some pre-existing disease such as kidney disease, hypothyroidism, obesity and cholestasis. And the drug. of choice for treating lipid disorder are the statins.

There’s a lot of scare stories about statins out there, a lot of them put about by people who sell so-called (unproven) cures. This is why this article only cites good research and findings by reputable bodies. Beware what you read on the internet!

So- a meta analysis of the trials of statins has shown that they do confer benefit on patients at increased risk of cardio vascular disease, mainly in men and women over 65 with increased risk factors, and particularly when combined with exercise (Brugts et al. 2009; Greenhill 2012). The benefits exceed the risks in most cases, although some patients with active or chronic liver disease may need a different approach (Calderon et al. 2010).

Side effects have been shown to be memory loss and confusion ,and  raised blood sugar levels leading to type 2 diabetes, particularly in postmenopausal women (FDA 2011; Culver 2012).  The benefits of statins are still seen as outweighing the risk of diabetes (Ridker et al. 2012). Severe muscle problems can also be caused by statins  (FDA 2012)and lovastin in particular  can interact with other medication and lead to muscle damage (FDA 2011).

There are some alternatives to statins for the treatment of dyslipedemia:-

• ·         ‘Functional foods’, i.e. foods that either increase health and well being or reduce health risks. For lipid disorders, soluble fibre (from oats and psyllium), soya protein and dark chocolate have all been shown to have a positive effect (Sirtori et al. 2009).
• ·         Fish oil has a positive effect on dyslipedemia, more precisely omega 3 at 4 g daily (Goldberg & Sabharwal 2008).
• ·         Fenofibrate has been found to be effective, with or without statins (McKeage & Keating 2011), as has gemfibrazil (Fazio 2008) and niacin (Jellinger et al. 2012).

I hope this has been helpful. Personally, at nearly 60 I am approaching the danger zone. My solution already encompasses a healthy diet (see January’s blog ‘Food for a lifestyle change’) but I am happy to add more oats, soya protein and dark chocolate, as well as a straightforward Omega 3 supplement.  Hopefully that will keep my cholesterol levels down!

Bibliography

Agoşton-Coldea, L. et al., 2007. Prevalence and particularities of dyslipidaemia in subjects with coronary heart disease. Romanian journal of internal medicine = Revue roumaine de médecine interne, 45(4), pp.341–347.

American Heart Foundation, Good vs bad cholesterol. Available at: American Heart Organisation.

Brugts, J.J. et al., 2009. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ, 338(jun30 1), pp.b2376–b2376.

Calderon, R.M. et al., 2010. Statins in the Treatment of Dyslipidemia in the Presence of Elevated Liver Aminotransferase Levels: A Therapeutic Dilemma. Mayo Clinic Proceedings, 85(4), pp.349–356.

Culver, A.L., 2012. Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women’s Health Initiative. Archives of Internal Medicine, 172(2), p.144.

Fazio, S., 2008. Management of mixed dyslipidemia in patients with or at risk for cardiovascular disease: a role for combination fibrate therapy. Clinical therapeutics, 30(2), pp.294–306.

FDA, 2012. Consumer Updates - Controlling Cholesterol with Statins. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048496.htm [Accessed February 18, 2013].

FDA, 2011. Consumer Updates - FDA Expands Advice on Statin Risks. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm [Accessed February 18, 2013].

Goldberg, R.B. & Sabharwal, A.K., 2008. Fish oil in the treatment of dyslipidemia. Current opinion in endocrinology, diabetes, and obesity, 15(2), pp.167–174.

Greenhill, C., 2012. Dyslipidaemia: Exercise reduces mortality in patients receiving statins. Nature Reviews Endocrinology, 9(2), pp.66–66.

Jellinger, P., Smith, D. & Mehta, A., 2012. AACE Lipid and Atherosclerosis Guidelines. , 18(Supplement 1).

McKeage, K. & Keating, G.M., 2011. Fenofibrate: a review of its use in dyslipidaemia. Drugs, 71(14), pp.1917–1946.

Mooradian, A., 2009. Dyslipidemia in type 2 diabetes mellitus. Nature Clinical Practice, 5(3), pp.150–157.

Neely, D., 2012. How can we improve clinical diagnosis of dyslipidemia? British Journal of Cardiology, 19.

Ridker, P.M. et al., 2012. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. The Lancet, 380(9841), pp.565–571.

Segala, M., 2003. Disease prevention and treatment. 4th ed., Ft. Lauderdale  FL: Life Extension Foundation.

Segala, M. & Life Extension Foundation., 2003. The Life Extension Foundation’s disease prevention and treatment : scientific protocols that integrate mainstream and alternative medicine Expanded 4th ed., Hollywood  Fla.: Life Extension Media.

Sirtori, C.R. et al., 2009. Functional foods for dyslipidaemia and cardiovascular risk prevention. Nutrition research reviews, 22(2), pp.244–261.

The Free Dictionary, cholesterol. The Free Dictionary.

World Heart Federation, 2013. Cardiovascular disease risk factors.